Xiang Yangfang, Li Jun, Sun Yinxiang
Pharmacy Department Cardiovascular Medicine Department, People's Hospital of Zhuhai City, Zhuhai City, China.
Medicine (Baltimore). 2018 Aug;97(32):e11810. doi: 10.1097/MD.0000000000011810.
Treprostinil, a potent vasodilator, is the treatment of choice for severe pulmonary arterial hypertension (PAH) during pregnancy. Its inhibition of platelet aggregation increases the risk of hemorrhage. In addition, anticoagulation therapy is widely used in pregnancy with PAH due to the hypercoagulable state. However, very little is known about the complications of anticoagulants' use in pregnancy with PAH.
A 27-year-old pregnant woman was admitted to the hospital at 32weeks with progressive dyspnea.
The pregnant was diagnosed with ventricular septal defect 12 years prior to presentation. Combining clinical manifestation with results of right heart catheterization (RHC) and echocardiography, it was consistent with severe World Health Organization (WHO) group I PAH.
Supportive treatment included supplemental oxygen, intravenous treprostinil, sildenafil and prophylactic anticoagulation.
Gastrointestinal bleeding is occurred in our patient when dalteparin were used in conjunction with treprostinil. Her care was further complicated refractory to usual conservative measures before delivery.
This case report illustrates the complexities that arise when prostacyclin therapies are combined with necessary anticoagulation in patients with PAH during pregnancy. More intention should play to the complications of anticoagulant in pregnancy with PAH during treprostinil therapy.
曲前列尼尔是一种强效血管扩张剂，是孕期重度肺动脉高压（PAH）的首选治疗药物。它抑制血小板聚集会增加出血风险。此外，由于高凝状态，抗凝治疗在PAH孕期广泛应用。然而，对于PAH孕期使用抗凝剂的并发症知之甚少。
一名27岁孕妇在孕32周时因进行性呼吸困难入院。
该孕妇在此次就诊前12年被诊断为室间隔缺损。结合临床表现、右心导管检查（RHC）和超声心动图结果，符合重度世界卫生组织（WHO）I组PAH。
支持性治疗包括补充氧气、静脉注射曲前列尼尔、西地那非和预防性抗凝。
当达肝素与曲前列尼尔联合使用时，我们的患者发生了胃肠道出血。在分娩前，她的病情因常规保守措施无效而进一步复杂化。
本病例报告说明了孕期PAH患者在使用前列环素疗法并联合必要的抗凝治疗时出现的复杂性。在曲前列尼尔治疗期间，应更加关注PAH孕期使用抗凝剂的并发症。
